Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions

Geist, Claudia; Aiken, Abigail R.A.; Sanders, Jessica N.; Everett, Bethany G.; Myers, Kyl; Cason, Patty; Simmons, Rebecca G.; Turok, David K.

doi:10.1016/j.contraception.2018.08.014

Cited by 32 publications

(32 citation statements)

References 17 publications

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“…For now, a starting point could be the recommendation that all rheumatologists initiate FPCC with each of their reproductive‐age female patients, to better ascertain their reproductive goals and/or referral needs. Specific open‐ended phrasing that has been developed for the general population could help rheumatologists to initiate these conversations as part of routine office workflow (e.g., electronic medical records or intake forms): 1) PATH (Pregnancy Attitudes, Timing and How important is pregnancy prevention) questions (e.g., Do you think you might like to have [more] children at some point?”), or 2) One Key Question (“Would you like to become pregnant in the next year?”) . In addition, trained rheumatology nurses have been found to enhance patient satisfaction and care for other aspects of rheumatologic care ; they might potentially help to provide aspects of FPCC for patients, including facilitating appropriate referrals for reproductive health care.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study

Talabi

Clowse

Blalock

et al. 2020

Arthritis Care & Research

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Objective Little is known about whether and how rheumatologists provide family planning counseling and reproductive health care (FPCC) to reproductive‐age women with rheumatic diseases. This qualitative study sought to assess rheumatologists’ perspectives, attitudes, and practices regarding FPCC. Methods Semistructured interviews were conducted with a geographically diverse US sample of rheumatologists (n = 12). Interviews were transcribed verbatim, and a code book was inductively developed based on transcript content. Two coders applied the code book to all transcripts, and coding differences were adjudicated to full agreement. The finalized coding was used to conduct a thematic analysis. Results Six themes were identified across interviews. Rheumatologists said that they 1) feel responsible for providing some FPCC to patients, 2) experience tension between respecting patients’ autonomy and their own anxieties about managing high‐risk pregnancies, 3) view patient‐initiated conversations as FPCC facilitators, and they regard lack of guidelines and the presence of competing clinical priorities as barriers to FPCC, 4) are reluctant to prescribe contraception, 5) desire greater access to resources to help guide FPCC, and 6) recognize the benefits of multidisciplinary collaboration with gynecologists. Conclusion Rheumatologists feel a sense of responsibility to provide some aspects of FPCC to reproductive‐age female patients. However, their own apprehensions about managing complicated pregnancies may negatively influence how they advise patients about pregnancy planning or avoidance. Rheumatologists do not prescribe contraception but rarely refer patients to gynecologists for contraceptive care. Future work should focus on eliminating barriers and identifying solutions that support rheumatologists’ efforts to provide high‐quality FPCC to patients.

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Section: Discussionmentioning

confidence: 99%

Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study

Talabi

Clowse

Blalock

et al. 2020

Arthritis Care & Research

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“…Data on pregnancy intention and feelings regarding a potential pregnancy were obtained using the PATH questions, which assess Pregnancy Attitudes, Timing, and How important is prevention. 16,17 At each follow-up event (1-, 3-, and 6-month surveys), participants indicated which method(s) of contraception they had used in the past 4 weeks. For the purposes of this study, we classified participants as having switched methods if they reported in the 1-, 3-, or 6month survey that they 1) had used a contraceptive method in the past 4 weeks that differed from their initial method, and also 2) did not report using their initial method in the past 4 weeks or reported that they had stopped using their initial method.…”

Section: Data Collectionmentioning

confidence: 99%

Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants

Simmons

Sanders

Geist

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Nearly half of women will switch or discontinue using their selected contraceptive method in the first year. Research on early switching or discontinuation provides important clinical and public health insights, although few studies have assessed associated factors, particularly among longitudinal cohorts. OBJECTIVE: The current study explores attributes associated with early contraceptive method switching or discontinuation (<6 months of initiation) among participants enrolled in the intervention cohorts of the Highly Effective Reversible Contraceptive Initiative Salt Lake Contraceptive Initiative (Utah, United States). MATERIALS AND METHODS: Highly Effective Reversible Contraceptive Initiative Salt Lake participants have access to no-cost contraception for 3 years. This includes both the initial selection and the ability to switch or to discontinue methods without cost. Methods available included the following: nonhormonal behavioral methods (male/female condoms, withdrawal, diaphragms, cervical caps, and fertility awareness); short-acting methods (pill, patch, ring, and injectable); and long-acting methods (intrauterine devices and contraceptive implants). Participants completed surveys at baseline and at 1, 3, and 6 months. We collected data on participant demographics, contraceptive continuation, switching, and discontinuation, as well as factors associated with these changes, including established measures of pregnancy intention and ambivalence and reasons for switching or discontinuing. We conducted descriptive statistics, univariable, and multivariable Poisson regression analyses to assess predictors of both discontinuation and switching. We also conducted χ 2 analyses to compare reported reasons for stopping between switchers and discontinuers. RESULTS: At 6 months, 2,583 women (70.0%) reported continuation of their baseline method, 367 (10%) reported at least 1 period of discontinuation, 459 (12.4%) reported switching to a

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“…The measures used for population-level surveillance of national-and state-level estimates of unintended pregnancy in the United States, and the ones critiqued by the authors, are retrospective measures. [51][52][53][54][55][56][57][58] As evidence of the potential for significant bias in these estimates, Potter et al cite Stevenson and Potter's (2015) analysis simulating the impact of retrospective reporting error on unintended pregnancy rates [59]. Yet, the magnitude and direction of this reporting error for pregnancy intentions in U.S.-based data are not clear [43,60,61].…”

Section: Critique: the Measure Is Likely Biased Because Of Reporting mentioning

confidence: 99%

Challenging unintended pregnancy as an indicator of reproductive autonomy: a response

Kost

Zolna

2019

Contraception

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(K. Kost). 1 We recognize that many trans men, gender-nonbinary and gender-nonconforming people also often need reproductive health care to either prevent or support pregnancy. Unfortunately, most data sources with pregnancy intentions measures do not allow researchers to identify these populations; some data sources do not even include these individuals. Because of these data limitations, we generally use the term "women" to describe the group of individuals for which we have data, but recognize that this does not necessarily include the experiences of everyone who is able to become pregnant. 2 While the issues raised throughout are relevant to ongoing discussions of how we approach research work globally, the extent of the expertise of the authors of this response necessarily limits our perspective to the body of research work focused on unintended pregnancy in the United States.

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Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions

Abstract: Pregnancy attitudes, plans and emotions inform clients' contraceptive needs and behaviors. Client-centered contraceptive care may benefit from a more nuanced PATH approach rather than relying on a single time-oriented question about pregnancy intention.

Cited by 32 publications

References 17 publications

Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study

Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study

Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants

Challenging unintended pregnancy as an indicator of reproductive autonomy: a response

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